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Abstract：
BACKGROUND: In contemporary guidelines for the management of Chronic Obstructive Pulmonary Disease (COPD), the history of acute exacerbations plays an important role in the choice of long-term inhaled therapies. This study aimed at evaluating population-level trends of filled inhaled prescriptions over the time course of COPD and their relation to the history of exacerbations.
METHODS: We used administrative health databases in British Columbia, Canada (1997-2015), to create a retrospective incident cohort of individuals with diagnosed COPD. We quantified long-acting inhaled medication prescriptions within each year of follow-up and documented their trend over the time course of COPD. Using generalized linear models, we investigated the association between the frequent exacerbator status (≥2 moderate or ≥1 severe exacerbation(s) in the previous 12 months) and filling a prescription after a physician visit.
RESULTS: 132,004 COPD patients were included (mean age 68.6, 49.2% female). The most common medication class during the first year of diagnosis was inhaled corticosteroids (ICS, used by 49.9%), followed by long-acting beta-2 adrenoreceptor agonists (LABA, 31.8%). Long-acting muscarinic receptor antagonists (LAMA) were the least commonly prescribed (10.4%). ICS remained the most common prescription throughout follow-up, being used by approximately 50% of patients during each year. 39.0% of patients received combination inhaled therapies in their first year of diagnosis, with ICS+LABA being the most common (30.7%). The association with exacerbation history was the most pronounced for triple therapy with an odds ratio (OR) of 2.68 for general practitioners and 2.02 for specialists (p<0.001 for both). Such associations were generally stronger among GPs compared with specialists, with the exception of monotherapy with LABA or ICS.
CONCLUSIONS: We documented low utilization of monotherapies (specifically LAMA) and high utilization of combination therapies (particularly ICS containing). Specialists were less likely to consider exacerbation history in the choice of inhaled therapies compared with GPs.
METHODS: We used administrative health databases in British Columbia, Canada (1997-2015), to create a retrospective incident cohort of individuals with diagnosed COPD. We quantified long-acting inhaled medication prescriptions within each year of follow-up and documented their trend over the time course of COPD. Using generalized linear models, we investigated the association between the frequent exacerbator status (≥2 moderate or ≥1 severe exacerbation(s) in the previous 12 months) and filling a prescription after a physician visit.
RESULTS: 132,004 COPD patients were included (mean age 68.6, 49.2% female). The most common medication class during the first year of diagnosis was inhaled corticosteroids (ICS, used by 49.9%), followed by long-acting beta-2 adrenoreceptor agonists (LABA, 31.8%). Long-acting muscarinic receptor antagonists (LAMA) were the least commonly prescribed (10.4%). ICS remained the most common prescription throughout follow-up, being used by approximately 50% of patients during each year. 39.0% of patients received combination inhaled therapies in their first year of diagnosis, with ICS+LABA being the most common (30.7%). The association with exacerbation history was the most pronounced for triple therapy with an odds ratio (OR) of 2.68 for general practitioners and 2.02 for specialists (p<0.001 for both). Such associations were generally stronger among GPs compared with specialists, with the exception of monotherapy with LABA or ICS.
CONCLUSIONS: We documented low utilization of monotherapies (specifically LAMA) and high utilization of combination therapies (particularly ICS containing). Specialists were less likely to consider exacerbation history in the choice of inhaled therapies compared with GPs.
摘要：
■在当代慢性阻塞性肺疾病（COPD）管理指南中，急性加重史对长期吸入疗法的选择具有重要作用.这项研究旨在评估充盈吸入处方在COPD时间过程中的人群水平趋势及其与恶化史的关系。
■我们使用了不列颠哥伦比亚省的行政健康数据库，加拿大（1997-2015），建立诊断为COPD患者的回顾性事件队列.我们在随访的每一年内对长效吸入药物处方进行了量化，并记录了它们在COPD时程中的趋势。使用广义线性模型，我们调查了频繁加重状态(前12个月内≥2次中度或≥1次重度加重)与就诊后按处方配药之间的关联.
■132,004例COPD患者（平均年龄68.6，49.2%为女性）。诊断第一年最常见的药物类别是吸入性皮质类固醇（ICS，使用率为49.9%)，其次是长效β-2肾上腺素受体激动剂(LABA，31.8%）。长效毒蕈碱受体拮抗剂（LAMA）是最不常见的处方（10.4％）。在整个随访期间，ICS仍然是最常见的处方，每年约有50%的患者使用。39.0%的患者在诊断的第一年接受联合吸入疗法,ICS+LABA是最常见的(30.7%)。对于三联疗法，与恶化史的关联最明显，全科医生的比值比（OR）为2.68，专家为2.02（两者均p<0.001）。与专家相比，全科医生的这种协会通常更强，除了LABA或ICS的单一疗法。
我们记录了单一疗法（特别是LAMA）的低利用率和联合疗法（特别是含ICS）的高利用率。与全科医生相比，专家在选择吸入疗法时不太可能考虑恶化史。
■我们使用了不列颠哥伦比亚省的行政健康数据库，加拿大（1997-2015），建立诊断为COPD患者的回顾性事件队列.我们在随访的每一年内对长效吸入药物处方进行了量化，并记录了它们在COPD时程中的趋势。使用广义线性模型，我们调查了频繁加重状态(前12个月内≥2次中度或≥1次重度加重)与就诊后按处方配药之间的关联.
■132,004例COPD患者（平均年龄68.6，49.2%为女性）。诊断第一年最常见的药物类别是吸入性皮质类固醇（ICS，使用率为49.9%)，其次是长效β-2肾上腺素受体激动剂(LABA，31.8%）。长效毒蕈碱受体拮抗剂（LAMA）是最不常见的处方（10.4％）。在整个随访期间，ICS仍然是最常见的处方，每年约有50%的患者使用。39.0%的患者在诊断的第一年接受联合吸入疗法,ICS+LABA是最常见的(30.7%)。对于三联疗法，与恶化史的关联最明显，全科医生的比值比（OR）为2.68，专家为2.02（两者均p<0.001）。与专家相比，全科医生的这种协会通常更强，除了LABA或ICS的单一疗法。
我们记录了单一疗法（特别是LAMA）的低利用率和联合疗法（特别是含ICS）的高利用率。与全科医生相比，专家在选择吸入疗法时不太可能考虑恶化史。
